Kaposi's sarcoma

Pulmonary KS may occur in up to 20 to 25 per cent of patients with cutaneous KS. The presenting symptoms of pulmonary KS are indistinguishable from those of opportunistic pathogens that cause pneumonia. It most frequently presents with the symptoms of cough or dyspnea; however, fever, hemoptysis, and stridor have been reported to occur secondary to pulmonary KS. Roentgenographically, pulmonary KS may present as diffuse infiltrates, nodal disease, and/or pleural effusions. The diagnosis is established by a characteristic histologic pattern obtained from large pieces of tissue, that is, from open lung biopsy or autopsy rather than from transbronchial biopsy. No effective therapy for pulmonary KS exists; however, short-term palliation may be achieved with radiotherapy or combination chemotherapy. In a patient with known pulmonary KS who develops either new or changing symptoms or new roentgenographic findings, an attempt should be made to rule out an associated infectious process.     

Kaposi's sarcoma

We have evaluated 19 homosexual/bisexual male patients with biopsy-proven Kaposi's sarcoma (KS) of the skin in order to define the extent of gastrointestinal involvement and determine its correlation with oral mucosal disease, skin findings, and immunologic function. Nearly half the patients had oral mucosal lesions. In patients with oral mucosal lesions, 75% had gastrointestinal lesions. Some gastrointestinal involvement during the period of observation was present in 10 of the 19 patients. Involvement of the upper gastrointestinal tract was more common than colonic involvement: esophagus 1, stomach 8, duodenum 3, and colon 6. Significant immunosuppression was observed in these patients, measuredin vitro by natural killer (NK) assay, and lymphocyte proliferation response to mitogens.     

Kaposi's sarcoma

An aggressive form of Kaposi's sarcoma has been reported in patients with acquired immunodeficiency syndrome. Although pulmonary symptoms may constitute the initial complaint, Kaposi's sarcoma is generally detected because of cutaneous lesions. The chest radiograph reveals a distinctive, poorly marginated, nodular pattern in the lungs. Coarse, linear densities are also observed, and pleural effusion is seen in many patients. Bilateral distribution is most common. Pulmonary hemorrhage occurs and rarely may result in dense air-space consolidation seen on the chest radiograph.     

HIV-Associated Kaposi's Sarcoma

A 25-year-old man was diagnosed with HIV infection and a CD4 count of 21/μl. He presented with chills, fever up to 39.5°C and dry cough since 1 week. Antibiotic treatment for suspected pneumonia resulted in some clinical improvement. He had a blackish spot on his right forearm, which slowly evolved into a firm nodule (panel A), and a small purple spot on the hard palate. Both were interpreted as Kaposi's sarcoma (KS). Endoscopy revealed no gastrointestinal or pulmonary lesions. Human herpes virus 8 (HHV8) IgG EIA was negative both initially and after starting highly active antiretroviral therapy (HAART). Despite an increase of CD4 to 207/μl, the oral nodule evolved into a prominent tumor of 2.5x2.5 cm (panel B). Biopsy confirmed KS, showing irregular vascular spaces, prominent endothelium, extravasated erythrocytes, and atypical spindle cells positive for CD31, CD34 and HHV8 (panel C). Several weeks later, the patient developed increasing dyspnea; a CT scan revealed perihilar, radially configured pulmonary infiltrates predominantly of the left lower lobe (panel D), consistent with pulmonary KS. HIV-associated KS affects the skin and/or mucous membranes and is strictly associated with HHV8 coinfection. However, HHV8 serology may be unreliable especially in the setting of severe immunodeficiency. Usually, immune reconstitution with HAART leads to resolution of KS, but in some cases chemotherapy may be necessary. Treatment with liposomal doxorubicin led to rapid improvement of his dyspnea, weight gain of 3 kg within 6 weeks, and complete flattening of the lesion on the palate within 9 weeks.     

Hepatosplenic AIDS-related Kaposi's sarcoma

Abdominal ultrasonography (US) and computed tomography (CT) were performed in one patient with acquired immunodeficiency syndrome (AIDS) and biopsy-proven hepatosplenic Kaposi's sarcoma. Small hyperechoic nodules were seen in the liver and spleen at US. CT revealed hepatosplenomegaly and low-attenuation focal lesions in the liver. These findings, although nonspecific, are suggestive of hepatosplenic involvement in Kaposi's sarcoma.     

Detection and quantification of Kaposi's sarcoma-associated herpesvirus to predict AIDS-associated Kaposi's sarcoma

OBJECTIVE: To identify immunologic and virologic predictors of AIDS-associated Kaposi's sarcoma (KS). DESIGN: Nested case-control analysis of KS risk in a cohort of 132 HIV-infected homosexual men in New York and Washington, DC, USA. METHODS: For each KS case, we selected two HIV-infected controls, matched for CD4 cell count and Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8; KSHV) serostatus (enzyme immunoassay for antibody to KSHV protein K8.1). Cell-associated KSHV and Epstein-Barr virus (EBV) viral loads were measured with quantitative real-time PCR assays on samples collected 1 year (median) before KS diagnosis. RESULTS: Thirty-one men developed AIDS-associated KS (incidence 3.1 per 100 person years). Among HIV-infected men, KS incidence was higher among those with K8.1 seropositivity (5.0 versus 1.4 per 100 person years; P = 0.004), low CD4 cell count [hazard ratio (HR), 1.49; 95% confidence interval (CI), 1.24-1.79 per 100 x 10(6) cells/l decline), or high HIV RNA level (HR, 3.96; 95% CI, 2.19-7.16 per log(10)). In the case-control analysis, nine of 70 evaluated subjects had KSHV viremia, generally low level (median viral load 180 copies per 1 x 10(6) cells). KSHV viremia was associated with increased KS risk (unadjusted odds ratio, 9.1; 95% CI, 1.7-48; odds ratio, 11.7; 95% CI, 1.8-76 after adjustment for K8.1 serostatus, CD4 cell count, and HIV RNA). Among K8.1-seropositive subjects, KS incidence was tenfold higher in those with KSHV viremia (30.3 per 100 person years versus 3.4 per 100 person years in those without viremia). Also, EBV viral loads were higher in cases than in controls (P = 0.07). CONCLUSIONS: Among individuals with HIV-KSHV coinfection, KSHV viremia identifies a subgroup with extremely high risk for developing KS.     

Kaposi's syndrome following transplantation

Kaposi's sarcoma has particularly been described after renal transplantation. More recently, a number of cases have been reported after hepatic or cardiac transplantation. The fostering factors are the same as for the other Kaposi's sarcomas, while the HIV1 or HIV2 serology is always negative. Renal transplantation may increase the natural risk of Kaposi's sarcoma by a factor of 4 to 500. The immunodepressive treatment must be reduced in case of purely cutaneous Kaposi and interrupted in case of visceral involvement. Death generally occurs as a consequence of infections. Kaposi's sarcoma after heart transplantation has a poorer prognosis, with fatal evolution in the four cases observed out of the 967 cardiac transplantations performed in the Ile-de-France region from 1968 to 1990; the cause of death most often is graft rejection or an infection.